Intradialytic Exercise Improves Physical Functioning

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For patients with kidney failure on dialysis, supervised exercise training during dialysis sessions leads to improvements on key functional tests, according to a clinical trial report in NEJM Evidence.

The randomized Dialysis Training Therapy (DiaTT) trial enrolled 1211 patients with chronic kidney failure undergoing hemodialysis at 21 German centers. The mean age was 66 years, and approximately 60% of patients were men. Patients at intervention centers received intradialytic exercise for 60 minutes during three weekly dialysis sessions. This included 30 minutes of endurance exercise using a bed-cycle ergometer and 30 minutes of resistance exercise using elastic bands, exercise bells, and dumbbells.

Patients at control centers received routine dialysis care. Performance on the 60-second sit-to-stand test (STS60) was assessed after 12 months, along with other exercise performance measures. Data analysis included 917 patients.

Performance on the STS60 improved from 16.2 to 19.2 repetitions in the exercise group compared with a decline from 16.2 to 14.7 repetitions in controls. The exercise group also had improvements of −1.1 seconds on the timed up-and-go test and 37.5 minutes on the 6-minute walk test.

The exercise intervention was associated with improvements in the physical summary score and vitality subscale of the 36-item Short Form Health Survey, with no change in other subscales. The exercise group also had fewer annual hospital days: median 2 versus 5 days. Adverse events were similar between groups, including events during dialysis sessions.

The DiaTT trial supports the benefits of supervised, intradialytic exercise sessions in a real-world hemodialysis setting, with significant improvements in physical functioning measures. The study included the development and implementation of a home-based exercise program in response to disruptions caused by the COVID-19 pandemic [Anding-Rost K, et al. Exercise during hemodialysis in patients with chronic kidney failure. NEJM Evid 2023; 2:1–11.].